Provider Demographics
NPI:1457501074
Name:CRUM, DONNA RAE (LPN)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:RAE
Last Name:CRUM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 NELSON RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-9610
Mailing Address - Country:US
Mailing Address - Phone:570-686-5000
Mailing Address - Fax:
Practice Address - Street 1:120 NELSON RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-9610
Practice Address - Country:US
Practice Address - Phone:570-686-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231195-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse